Why Are Sexual Assault Survivors Being Turned Away From Hospitals?

by Eleonor Botoman

If you’ve seen an episode of Law & Order: SVU or sat through an on-campus sexual assault awareness course (as many college freshmen are doing now at their college orientation), you’re probably familiar with the procedure for what to do after a sexual assault. One of the first things you are told to do is go to the hospital and get a rape kit.

The rape kit backlog is an issue we have been aware of for quite some time. The Joy Heart Foundation’s program ENDTHEBACKLOG estimates that hundreds of thousands of untested rape kits sit untested in storage facilities across the country, however, the problem doesn’t just lie with kit testing. There is a critical shortage of nurses who are specially trained to perform sexual assault evidence collection, and it’s seriously hurting victims who are trying to seek help.

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The SANE (Sexual Assault Nurse Examiner) is trained to carefully collect forensic samples so that the kit does not violate chain of custody after the rape kit exam (the exam itself can last anywhere between two and four hours). The SANE speaks to the victim about the attack, provides emotional support and emergency contraception. The SANE makes a detailed assessment of the victim’s physical injuries and psychological traumas. The SANE can testify in court so that the evidence will be held admissible. The SANE is very, very important, and yet only 13% of hospitals employ them nationwide.

So why are there so few of these nurses?


The problem starts with the fact that there is no national standard for training medical professionals in performing sexual assault exams. This past March, the Government Accountability Office (GAO) found that in half of the states that received Department of Justice funding for forensic training fewer than 100 examiners ended up with proper training. In rural areas, state officials from Wisconsin reported that nearly half of their counties don’t have a single examiner available, and the hospitals that employ examiners cannot guarantee 24/7 examiner coverage.

Although the DOJ has expressed concern over the lack of SANEs, lack of government funding gives hospitals very little incentive to cover the cost of nurse training as well as pay already-trained examiners for being on-call. Due to lack of guidelines, the emotional exhaustion that comes from long on-call shifts and the strain of understaffing, the GAO discovered that in Wisconsin “while the state trained 540 examiners over a two-year period, only 42 of those examiners were still practicing in the state at the end of those two years.” This high turnover rate leaves victims with very few adequate resources.

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One SANE program manager, Terri Slapak-Fugate, wrote about her own experience being a poorly equipped nurse trying to collect rape kit evidence, fearful that she was ruining her patients’ court cases. This worry was justifiable, as a Colorado study found that Non-SANE nurses were more likely to compromise the integrity of their kits and collect the wrong number of samples than their trained counterparts.

Cosmopolitan, just this week, published the story of a woman who had to bounce around different Houston emergency rooms for 9 hours until she finally received a rape kit examination. By that point, the drugs her attacker used were already out of her system, and she never found out her results. After the ordeal, she says, “I was equally victimized by this system as I was by the guy [who raped me]. I tried to handle the situation responsibly but it was out of my hands.” Another woman, named Leah, told CNN about her experience trying to get proper care. She was still in a daze from her attacker’s drugs when she was told that she would have to drive 30 minutes to the only hospital in her county that offered a rape kit exam. An untrained doctor missed a laceration inside her vagina when she was examined.

Rape is already seriously underreported. If a victim is forced to endure hours of travel from one hospital to another after being turned away by emergency rooms, then it’s no surprise that they will lose the motivation to pursue criminal prosecution. Survivors are left to suffer, despite the great strength it took for them to seek medical care in the first place.

What can be done?

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Individual hospital programs cannot improve until a national standard is set for the training and employment of SANE nurses. Luckily, steps are already being taken to prevent more of these horror stories from happening.

Following the release of the GAO report, Senator Patty Murray (D-WA) introduced the Survivor’s Access to Supportive Care Act (SASCA) in hopes of increasing victims’ access to SANEs and other sexual assault care services. The act also calls for the development of national standards of care for sexual assault survivors and would direct the Department of Health and Human Services to establish a national training and continuing education program.

Studies have already proven that SANEs provide effective care to victims. These nurses aid in physical and psychological recovery. Just their presence alone can provide victims with a safe space to speak about their attack. They know how to properly collect evidence for police investigations while sensitive to the needs of survivors. More importantly, they provide victims with justice, which for many is an important part of the healing process. Their evidence collection procedures directly result in an increase of arrests and prosecutions.

Victims of sexual assault already face many obstacles when they speak up after their attack. Going to the hospital should not be one of them.

Photos via SANE of Butler CountyENDTHEBACKLOG, WKYT, Politifact, FABCO, Unity Point Health

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